Healthcare Provider Details

I. General information

NPI: 1376557348
Provider Name (Legal Business Name): JOHNSON CITY EMERGENCY PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 SUNSET DR SUITE 201
JOHNSON CITY TN
37604-3799
US

IV. Provider business mailing address

PO BOX 5576
JOHNSON CITY TN
37602-5576
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-6266
  • Fax: 423-926-7599
Mailing address:
  • Phone: 423-926-6266
  • Fax: 423-926-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GREGORY MICHEAL HYDER
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 423-926-6266